See the published version of this article at BMC Health Services Research.
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Research article
Suzan Hassan
University College London
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background: People with severe mental illness (SMI) are at greater risk of earlier mortality due to physical health problems including cardiovascular disease (CVD). There is limited work exploring whether physical health interventions for people with SMI can be embedded and/or adopted within specific healthcare settings. This information is necessary to optimise the development of services and interventions within healthcare settings. This study explores the barriers and facilitators of implementing a nurse-delivered intervention (‘PRIMROSE’) designed to reduce CVD risk in people with SMI in primary care, using Normalisation Process Theory (NPT), a theory that explains the dynamics of embedding or ‘normalising’ a complex intervention within healthcare settings .
Methods: Semi-structured interviews were conducted between April-December 2016 with patients with SMI at risk of CVD who received the PRIMROSE intervention, and practice nurses and healthcare assistants who delivered it in primary care in England. Interviews were audio recorded, transcribed and analysed using thematic analysis. Emergent themes were then mapped on to constructs of NPT.
Results: 15 patients and 15 staff participated. The implementation of PRIMROSE was affected by the following as categorised by the NPT domains: 1) Coherence, where both staff and patients expressed an understanding of the purpose and value of the intervention, 2) Cognitive participation, including mental health stigma and staff perceptions of the compatibility of the intervention to primary care contexts, 3) Collective action, including 3.1. Interactional workability in terms of lack of patient engagement despite flexible appointment scheduling. The structured nature of the intervention and the need for additional nurse time were considered barriers, 3.2. Relational integration i.e. whereby positive relationships between staff and patients facilitated implementation, and access to ‘in-house’ staff support was considered important, 3.3. Skill-set workability in terms of staff skills, knowledge and training facilitated implementation, 3.4. Contextual integration regarding the accessibility of resources sometimes prevented collective action. 4) Reflexive monitoring, where the staff commonly appraised the intervention by suggesting designated timeslots and technology may improve the intervention.
Conclusions: Future interventions for physical health in people with SMI could consider the following items to improve implementation: 1) training for practitioners in CVD risk prevention to increase practitioners knowledge of physical interventions 2) training in SMI to increase practitioner confidence to engage with people with SMI and reduce mental health stigma and 3) access to resources including specialist services, additional staff and time. Access to specialist behaviour change services may be beneficial for patients with specific health goals. Additional staff to support workload and share knowledge may also be valuable. More time for appointments with people with SMI may allow practitioners to better meet patient needs.
Keywords
Severe mental illness; physical health; cardiovascular disease; primary care; nurse; normalisation process theory; implementation science; qualitative; barriers; facilitators.
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CURRENT STATUS: Published
Version 4
Posted 10 Aug, 2020
Published
On 15 Aug, 2020
No community comments so far
Editorial decision: Accept
On 10 Aug, 2020
Editor assigned
On 04 Aug, 2020
Submission checks complete
On 03 Aug, 2020
Editor invited
On 03 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 10 Jul, 2020
Review #1 received
Received 05 Jul, 2020
Reviewer #1 agreed
On 13 Jun, 2020
Reviewers invited
Invitations sent on 12 Jun, 2020
Editor assigned
On 10 Jun, 2020
Submission checks complete
On 09 Jun, 2020
Editor invited
On 09 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 27 May, 2020
Review #3 received
Received 23 May, 2020
Review #2 received
Received 18 May, 2020
Review #1 received
Received 14 May, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Reviewer #3 agreed
On 26 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Reviewer #1 agreed
On 22 Apr, 2020
Editor assigned
On 21 Apr, 2020
Submission checks complete
On 20 Apr, 2020
Editor invited
On 20 Apr, 2020
No comments provided
Editorial decision: Major revision
On 24 Feb, 2020
Review #3 received
Received 10 Feb, 2020
Review #4 received
Received 10 Feb, 2020
Reviewer #4 agreed
On 03 Feb, 2020
Reviewer #3 agreed
On 31 Jan, 2020
Review #2 received
Received 19 Jan, 2020
Reviewer #2 agreed
On 04 Jan, 2020
Review #1 received
Received 10 Nov, 2019
Reviewer #1 agreed
On 21 Oct, 2019
Reviewers invited
Invitations sent on 14 Oct, 2019
Submission checks complete
On 01 Oct, 2019
Editor assigned
On 01 Oct, 2019
Editor invited
On 30 Sep, 2019
First submitted
On 27 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
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This preprint is under consideration at BMC Health Services Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Suzan Hassan
University College London
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 10 Aug, 2020
Published
On 15 Aug, 2020
No community comments so far
Editorial decision: Accept
On 10 Aug, 2020
Editor assigned
On 04 Aug, 2020
Submission checks complete
On 03 Aug, 2020
Editor invited
On 03 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 10 Jul, 2020
Review #1 received
Received 05 Jul, 2020
Reviewer #1 agreed
On 13 Jun, 2020
Reviewers invited
Invitations sent on 12 Jun, 2020
Editor assigned
On 10 Jun, 2020
Submission checks complete
On 09 Jun, 2020
Editor invited
On 09 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 27 May, 2020
Review #3 received
Received 23 May, 2020
Review #2 received
Received 18 May, 2020
Review #1 received
Received 14 May, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Reviewer #3 agreed
On 26 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Reviewer #1 agreed
On 22 Apr, 2020
Editor assigned
On 21 Apr, 2020
Submission checks complete
On 20 Apr, 2020
Editor invited
On 20 Apr, 2020
No comments provided
Editorial decision: Major revision
On 24 Feb, 2020
Review #3 received
Received 10 Feb, 2020
Review #4 received
Received 10 Feb, 2020
Reviewer #4 agreed
On 03 Feb, 2020
Reviewer #3 agreed
On 31 Jan, 2020
Review #2 received
Received 19 Jan, 2020
Reviewer #2 agreed
On 04 Jan, 2020
Review #1 received
Received 10 Nov, 2019
Reviewer #1 agreed
On 21 Oct, 2019
Reviewers invited
Invitations sent on 14 Oct, 2019
Submission checks complete
On 01 Oct, 2019
Editor assigned
On 01 Oct, 2019
Editor invited
On 30 Sep, 2019
First submitted
On 27 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background: People with severe mental illness (SMI) are at greater risk of earlier mortality due to physical health problems including cardiovascular disease (CVD). There is limited work exploring whether physical health interventions for people with SMI can be embedded and/or adopted within specific healthcare settings. This information is necessary to optimise the development of services and interventions within healthcare settings. This study explores the barriers and facilitators of implementing a nurse-delivered intervention (‘PRIMROSE’) designed to reduce CVD risk in people with SMI in primary care, using Normalisation Process Theory (NPT), a theory that explains the dynamics of embedding or ‘normalising’ a complex intervention within healthcare settings .
Methods: Semi-structured interviews were conducted between April-December 2016 with patients with SMI at risk of CVD who received the PRIMROSE intervention, and practice nurses and healthcare assistants who delivered it in primary care in England. Interviews were audio recorded, transcribed and analysed using thematic analysis. Emergent themes were then mapped on to constructs of NPT.
Results: 15 patients and 15 staff participated. The implementation of PRIMROSE was affected by the following as categorised by the NPT domains: 1) Coherence, where both staff and patients expressed an understanding of the purpose and value of the intervention, 2) Cognitive participation, including mental health stigma and staff perceptions of the compatibility of the intervention to primary care contexts, 3) Collective action, including 3.1. Interactional workability in terms of lack of patient engagement despite flexible appointment scheduling. The structured nature of the intervention and the need for additional nurse time were considered barriers, 3.2. Relational integration i.e. whereby positive relationships between staff and patients facilitated implementation, and access to ‘in-house’ staff support was considered important, 3.3. Skill-set workability in terms of staff skills, knowledge and training facilitated implementation, 3.4. Contextual integration regarding the accessibility of resources sometimes prevented collective action. 4) Reflexive monitoring, where the staff commonly appraised the intervention by suggesting designated timeslots and technology may improve the intervention.
Conclusions: Future interventions for physical health in people with SMI could consider the following items to improve implementation: 1) training for practitioners in CVD risk prevention to increase practitioners knowledge of physical interventions 2) training in SMI to increase practitioner confidence to engage with people with SMI and reduce mental health stigma and 3) access to resources including specialist services, additional staff and time. Access to specialist behaviour change services may be beneficial for patients with specific health goals. Additional staff to support workload and share knowledge may also be valuable. More time for appointments with people with SMI may allow practitioners to better meet patient needs.
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